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传染病死亡榜单：艾滋病连续三年排第一
稿源： 健康报网 编辑： 杨晨雨 本报记者 郑灵巧
近来接连有媒体报道称，当地艾滋病已成传染病死亡“首凶”。卫生部近期发布的疫情报告也显示，2010年全国报告艾滋病发病病例15982例，报告死亡病例7743例，这一死亡数在全国数十种法定报告传染病中名列第一。记者查阅了全国法定报告传染病疫情报告数据，发现在传染病死亡病例报告数排序中，艾滋病已经连续3年居于榜首。
每年报告艾滋病死亡人数在增多
记者从中国疾病预防控制中心(CDC)性病艾滋病预防控制中心获悉，过去5年，我国每年报告的艾滋病死亡人数增幅较大。2010年全国报告艾滋病死亡病例数是2006年报告死亡病例数的10倍多。艾滋病病人死亡在全国法定报告传染病死亡的构成比，也呈增长趋势。
来自全国艾滋病专报系统的数字显示，在2006年~2010年，全国报告的艾滋病病毒感染者和艾滋病病人每年因各种原因死亡的病例总数分别为1809例、5544例、9748例、12287例和18987例。其中，当年报告当年死亡病例分别为1723例、5445、8603例、11253例和13981例。
中国CDC性病艾滋病预防控制中心主任吴尊友教授称，我国艾滋病死亡病例主要分布在艾滋病病人与感染者报告例数较多的地区，死亡病例分布与疫情严重程度基本相一致。过去5年，艾滋病死亡病例报告增多的省共有16个。随着艾滋病防治工作的深入，既往死亡的一些病例也被追溯发现，纳入到报告数据库中。
八成艾滋病死亡病例发现时已是晚期
吴尊友指出，近年来，我国艾滋病死亡病例报告数大幅度增加，其最根本的原因是大量艾滋病病毒感染者陆续进入到病程晚期，有相当一部分感染者因为害怕招致社会歧视，一直不敢检测而处于隐蔽状态。在近5年报告的艾滋病死亡病例中，有高达80%的人未接受过抗病毒治疗。由于病情发现过迟，一经诊断，已到晚期，患者已来不及进行抗病毒药物治疗。
据介绍，中国CDC性病艾滋病预防控制中心曾对我国数万名艾滋病病人进行过长达5年的国家抗病毒队列研究，其中一个重要发现是，治疗过晚是患者最大的死亡风险因素。而导致治疗后死亡的两大关键指标分别是：治疗开始时CD4水平低于50个/微升；治疗开始时已有4个~5个机会性感染的症状和体征，如发烧、腹泻等。
中国CDC性病艾滋病预防控制中心治疗关怀室主任张福杰教授表示，如果将接受抗病毒治疗和未接受抗病毒治疗患者分开统计，我国艾滋病患者病死率差异显着。在2002年实施免费抗病毒治疗前，我国艾滋病病人病死率为30/100人年~40/100人年，而目前艾滋病病人总体病死率已经降至18/100人年。其中，接受抗病毒治疗的艾滋病病人的病死率已降至5/100人年，为发展中国家病死率最低水平。根据艾滋病进展规律，CD4细胞水平低于200个/微升的艾滋病患者如果得不到有针对性的抗病毒治疗，其绝大多数会在18个月内死亡。据此初步估算，2006年~2010年，我国因抗病毒治疗减少或延缓而死亡的艾滋病病人合计达3万多人。
死亡病例报告统计方法不相同
今年1月，全国传染病网络直报系统再度报告艾滋病死亡病例540例，而其他所有30多种甲类、乙类传染病总共报告死亡病例992例。其中，报告病例最多的各型病毒性肝炎所报告死亡病例仅有88例。
据了解，目前我国各类传染病死亡病例报告的统计方法不完全相同。例如，病毒性肝炎死亡病例报告统计有多个类别，死于暴发性肝衰竭者报告为病毒性肝炎死亡，死于肝硬化、肝癌者则报告为肝硬化、肝癌死亡。而所有登记的艾滋病病毒感染者，无论最终是死于其他疾病，还是意外死亡，均报告为艾滋病死亡病例。
中国CDC性病艾滋病预防控制中心归因分析显示，在2006年~2010年全国报告的艾滋病死亡病例中，艾滋病死亡约占45%。
吴尊友表示，尽管我国通过抗病毒治疗有效地把艾滋病病死率控制在稳定水平，但目前艾滋病死亡病例在所有传染病中报告数最多，已是不争的事实。在未来的5年，将在分析患者具体死因的基础上，力推早发现、早治疗措施，展开更有针对性的防治工作，减少新发感染，进一步降低艾滋病病死率，提高艾滋病预防控制水平，确保到2015年如期实现控制艾滋病疫情的千年发展目标。
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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Death list of infectious diseases: AIDS, ranked first for three consecutive years
Manuscript Source: Health News Editor: Zheng Yang Chenyu smart reporter
Recent series of media reports that the death of the local AIDS epidemic has become "the first fierce." Ministry of Health recently released the epidemic report also showed that in 2010 the country reported cases of 15,982 cases of AIDS incidence, 7743 cases of reported deaths, the deaths of dozens of statutory reporting in the country ranked first among infectious diseases. Reporter access to the National Notifiable Infectious disease reporting data, the report found that the number of deaths in the sort of infectious diseases, AIDS has topped the list for 3 years.
AIDS deaths are reported annually on the rise
Reporters from the Chinese Center for Disease Control and Prevention (CDC) STD and AIDS prevention and control center was informed that over the past 5 years, China's annual reported AIDS deaths increased considerably. National reporting in 2010 the number of AIDS deaths reported in 2006 death of more than 10 times the number of cases. AIDS patients die of infectious death in the country composition of the statutory ratio, also showed a rising trend.
Special Report from the National AIDS figures show the system in 2006 to 2010, the national reporting of HIV infected persons and AIDS patients for various reasons every year the total number of deaths were 1809 cases, 5544 cases, 9748 cases, 12,287 cases and 18,987 cases. Which, when reported cases of the year were 1723 cases of death, 5445,8603 cases, 11,253 cases and 13,981 cases.
STD and AIDS Control and Prevention, China CDC Director of the Centre Professor Wu Zunyou, said AIDS deaths in China are mainly distributed in HIV infected patients and the number of reported cases of large areas of distribution of deaths and the severity of the epidemic is essentially the same. Over the past 5 years, reported an increase in AIDS deaths in the province a total of 16. With the deepening of AIDS, the death of a number of previous cases have been retrospectively found incorporated into the report database.
Bacheng of AIDS deaths in an advanced stage when found
Mr Wu pointed out that in recent years, the number of reported cases of AIDS deaths increased significantly, its most fundamental reason is that a large number of HIV infected persons have moved into the late course of the disease, a considerable part of the infection for fear of incurring social discrimination, has not detected the in a hidden state. In the past 5 years of reported AIDS deaths, as many as 80% of people had not received antiretroviral treatment. As the disease found too late, once diagnosed, has come late, too late for patients with antiviral therapy.
According to reports, China CDC Center for STD and AIDS prevention and control tens of thousands of AIDS patients in China had been up to 5 years cohort study of national anti-virus, which is an important finding was that patients treated late is the biggest risk factor for death. Which led to death after treatment of the two key indicators are: the beginning of treatment CD4 level less than 50 / μL; the beginning of treatment have been 4 ~ 5 the symptoms of opportunistic infections and symptoms such as fever and diarrhea.
China CDC treatment of STD and AIDS prevention and control center, said Professor Zhang Fujie, director of care, if you are not receiving antiretroviral therapy and patients receiving antiretroviral treatment separate statistics, the mortality of AIDS patients were significantly different. In 2002, before the introduction of free antiretroviral therapy, AIDS mortality rate of 30/100 person-years ~ 40/100 person-years, and the current overall death rate of AIDS patients has dropped to 18/100 person-years. Among them, the receiving antiretroviral treatment of AIDS patients in the mortality rate has been reduced to 5 / 100 person-years, the lowest level of mortality in developing countries. Progress under the laws of AIDS, CD4 cell levels below 200 / μL with AIDS if they are not targeted anti-viral treatment, the vast majority will die within 18 months. Accordingly preliminary estimates, 2006 to 2010, China because of anti-viral therapy to reduce or delay the death of AIDS patients, amount to more than 3 million.
Death is not the same statistical methods Case Report
January of this year, the country again and reporting system of infectious diseases reported 540 cases of AIDS deaths, while all other 30 types A, B infectious diseases reported a total of 992 cases of deaths. Among them, the most reported cases of various types of viral hepatitis reported only 88 cases of deaths.
It is understood that the present case report of death of all infectious diseases, statistical methods are not identical. For example, viral hepatitis case reports of death statistics have more than one category, those who died of fulminant liver failure deaths reported as viral hepatitis, died of cirrhosis of the liver, liver cancer who were reported as cirrhosis, liver cancer death. And all registered HIV-infected persons, regardless died of other diseases, or accidental death, were reported as AIDS deaths.
STD and AIDS Control and Prevention, China CDC Center for attribution analysis shows that in the country from 2006 to 2010, reported AIDS deaths, AIDS deaths account for about 45%.
Mr Wu said that despite the country through anti-viral treatment effectively controlled at a stable level of AIDS mortality, but AIDS deaths reported in the largest number of all infectious diseases, is an indisputable fact. In the next 5 years, patients in the analysis, based on the specific cause of death, pushing early detection, early treatment, expand more targeted prevention work to reduce new infections, to further reduce AIDS mortality and improve the level of AIDS prevention and control to ensure that by 2015 the AIDS epidemic on schedule to achieve control of the Millennium Development Goals.
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